Potential Problems

The health of the kidneys is put at risk when a person has a severe infection, heart disease, medications that may hurt the kidneys, or previous problems with their kidneys. The kidneys can become overwhelmed by waste or toxic substances, or may be harmed by a lack of blood supply.

The following are some problems related to the kidneys and bladder that can happen in the MSICU:

Acute tubular necrosis (ATN) Azotemia
Acute renal failure (ARF) Uremia
Chronic renal failure (CRF) Electrolyte imbalances


Acute tubular necrosis (ATN)

A common cause of acute renal failure. The tubules are cells that form the tube carrying urine from the kidneys down to the bladder. They are needed to take back water from the newly-filtered urine and return it to the blood. If these cells are damaged or die, the body does not get the water it needs back from the kidneys.

The tubules are very sensitive to a lack of oxygen. If a person is in shock there may not be enough blood getting to the kidneys. Some drugs can harm the tubule cells as well. ATN is reversible by finding out the underlying problem and treating it as soon as possible.

Acute renal failure (ARF)

A rapid onset of kidney failure. There are a number of different causes of ARF. An example is shock, which causes a loss of blood with oxygen going to the organs. Shock can lead to kidney failure among other problems. The loss of kidney filtering of the blood means there are more waste products circulating in the body. This can stop other organs from working properly.

The loss of kidney filtering can also change the balance of water, salts, and acidity in the blood. The treatments are picked based on what is causing the kidney to fail. ARF is potentially reversible, but sometimes one or both kidneys are permanently damaged.

Chronic renal failure (CRF)




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A gradual onset of kidney failure. Chronic renal failure is most often associated with high blood pressure, diabetes, kidney infections, or disease. Sometimes it is called End Stage Renal Disease. As with acute renal failure, the treatment will depend on what is causing the problem. Most people with CRF use intermittent dialysis to replace the lost kidney function.
Edema Edema is a build up of fluid in the body’s tissues. If the kidneys are not working well, the blood can become overloaded with water. The water will go into the tissues, such as the lungs and under the skin. During a critical illness, a person may have so much edema that they look swollen and distorted. Edema will eventually go away if the underlying cause is found and treated.
Azotemia A build up of nitrogen-based waste products in the blood. May be caused by a lack of blood supply to the kidney, or a block in the tubes between the kidney and bladder. Azotemia is diagnosed by blood tests showing a higher level of urea and creatinine. The patient may feel itchy. This is caused by the build up of these waste products. These chemicals are normally taken out of the blood if the kidneys are working properly. Azotemia can progress to uremia.
Uremia Uremia is an excess of nitrogen-based productsin the blood, such as proteins. Early symptoms include tiredness and a lack of appetite. Waste products are toxic to cells and organs at higher concentrations. If the excess waste is not removed, uremia can progress to confusion and coma. The fastest way to clear the blood of waste is with dialysis.
Electrolyte imbalances The kidneys are essential to keeping the electrolytes of the body in balance. Examples include sodium, potassium, calcium, and magnesium. The electrolytes can become imbalanced for a number of reasons and it is the kidney’s job to keep what the body is running short on and get rid of excess. If the kidneys are not working well, the balance of minerals and the acidity of the blood is affected.

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